Paralytic brachial plexus neuritis, also known as neuralgic amyotrophy, has an unclear etiology, possibly related to infections or allergic reactions. Its main manifestations include pain, weakness, and muscle atrophy primarily in the shoulder girdle muscles. The onset is acute, and the prognosis is favorable. Brachial plexus damage caused by cervical spondylosis is not included.

bubble_chart Diagnosis

1. History and Symptoms:

More common in adults, often occurring after exposure to cold, common cold, or post-surgery. Acute or subacute onset, presenting with numbness, pain, weakness, and muscle atrophy in one side (rarely bilateral) of the neck, scapula, or upper limb muscles, with proximal symptoms being more severe than distal.

2. Physical Examination Findings:

Significant tenderness over the brachial plexus trunk (such as the supraclavicular or infraclavicular fossa, or axilla). Pain is induced by traction of the brachial plexus when the arm is abducted or raised. Sensory impairment is observed in the shoulder, lateral upper arm, and radial side of the forearm. The biceps and triceps tendon reflexes are weakened or absent.

3. Auxiliary Examinations:

1. Cerebrospinal fluid examination: Protein and cells may show grade I elevation.

2. Electromyography may reveal loss of vitality with neurogenic changes.

4. Differential Diagnosis:

This condition often needs to be differentiated from cervical radiculitis, inflammation of the neck and shoulder muscles, shoulder arthritis, and scapulohumeral periarthritis.

bubble_chart Treatment Measures

It can be treated in outpatient clinics, and the prognosis is generally good.

1. During the acute phase, the affected limb should rest, and the upper arm can be suspended in front of the chest with a wide band in a flexed elbow position.

3. Acupuncture points include Jianyu (LI15), Quchi (LI11), Waiguan (TE5), Lieque (LU7), and Houxi (SI3).

4. Adrenocortical steroids have the effect of subduing swelling to relieve pain. Prednisone 30–40 mg once daily can be taken orally.

5. Neurotrophic drugs: Citicoline 250 mg once daily, Vitamin B12 500 μg (1 mL) once daily, and Vitamin B1 20 mg three times daily, taken orally.

6. Nerve block therapy: 5 mL of 5% lidocaine can be used to block the brachial plexus and cervical sympathetic ganglia via the anterior and middle scalene muscle groove approach. Dexamethasone 2.5–5 mg can also be injected at the brachial plexus, twice weekly for 3–5 consecutive sessions.

For severe pain, carbamazepine 0.1 g three times daily can be taken orally.